Classified Golden File PDF

We have made every effort to classify sub-topics based on basic files. If you find a significant number of questions not categorized as sub-topic, please let us know so we can add that sub-topic, otherwise place them in the unclassified section Additionally, we've included a link for each sub-topi...

We have made every effort to classify sub-topics based on basic files. If you find a significant number of questions not categorized as sub-topic, please let us know so we can add that sub-topic, otherwise place them in the unclassified section Additionally, we've included a link for each sub-topic that will take you directly to that section when clicked in the table, we hope this makes navigation smoother for you Medicine 741 Cardiology 166 Pulmonology 121 Nephrology 37 Gastroenterology 134 Rheumatology 42 Infectious diseases 73 Endocrinology 119 Neurology 48 Onco-Hematology 32 Unclassified 11 Surgery 485 Trauma 42 Orthopaedic 43 Vascular 48 Thoracic 11 Endocrine (including breast) 53 Gastrointestinal 175 Obesity 1 Urology 18 Plastic 13 Neurosurgery 6 Otolaryngology 2 Post op complications 42 Unclassified 31 602 OB/GYNE  Obstetrics Contraindications to Pregnancy (Medications and Vaccines) 8 Cervical Incompetence 5 Antenatal care 18 Fetal Medicine 9 Hypertension in Pregnancy and Preeclampsia 19 Diabetes Mellitus and Gestational Diabetes Mellitus 9 Pregnancy Related Medical and Surgical Conditions 51 Antepartum Hemorrhage (APH) 7 Labor and CTG Monitoring 38 Preterm labor, Preterm Rupture of Membrane (PROM) and Premature Preterm Rupture of Membrane 17 (PPROM) Postpartum Hemorrhage (PPH) 0 Postpartum 28 Gynecology Puberty Disorders, Pediatrics, Adolescent and Young Gynecology 18 Menstrual Cycle Abnormalities and Abnormal Uterine Bleeding (AUB) 52 Vaginal Infections 41 Pelvic Inflammatory Disease (PID) 15 Contraception and Hormonal Replacement Therapy (HRT) 7 Abortion, Pregnancy Loss, and Intrauterine Fetal Demise (IUFD) 26 Ectopic Pregnancy 25 Gestational Trophoblastic Disease (Molar pregnancy and Choriocarcinoma) 5 Adnexal masses 15 Leiomyoma (Uterine Fibroids) and Leiomyosarcoma 9 Endometriosis 11 Adenomyosis 2 Asherman's Syndrome 1 Cervical Cancer and Screening 26 Vulvar and vaginal cancer 1 Endometrial Polyp, Hyperplasia and Carcinoma 16 Urogynecology 26 Unclassified 89 Pediatrics 678  Milestones 44 Infectious diseases 94 Vaccination 46 Gastroenterology 94 Respiratory 70 Rheumatology 12 Nephrology 36 Hematology 27 Cardiology 52 Neurology 31 Endocrinology 72 Genetics 14 Unclassified 91 Ethics 73 Psychiatry 131 Emergency Medicine 32 Unclassified 49 Cardiology 1-A 65-year-old man with diabetes and hypertension is admitted with extensive anterior ST elevation myocardial infarction (STEMI). had successful angioplasty and stenting to left anterior descending artery. Aspirin, clopidogrel, bisoprolol and enalapril were started (see lab results). Test Result Normal Values Cholesterol (HDL) 1.0 > 1.03 mmol/L Cholesterol (LDL) 3.36 20 tablets, 3 hours ago. On examination, she has acute abdominal pain, with nausea, vomiting and diarrhea, and she passed 2 times melaena. Blood pressure 100/60 mmHg, Heart rate 120 /min, Respiratory rate 26 /min, Temperature 36.6 °C Which of the following is the most appropriate treatment option at this stage? A. Gastric lavage B. N acetylcysteine C. Intravenous desferrioxamine D. No antidote required at this stage Answer: C 90- Newborn delivered with ventouse due to malposition. While assessment in the nursery, a hematoma from bleeding below the periosteum confined within the margins of the skull sutures noted. Which of the following is the most likely diagnosis? A. Chignon B. Cephalohematoma C. Caput succedaneum D. Subaponeurotic hematoma Answer: B 91- Which of the following is a known side effect of beclomethasone use in children? A. Intraocular hypertension B. Excitable behaviour C. Sleep disturbance D. Growth retardation Answer: D  Nephrology 1- An 8-year-old girl is referred to the paediatric nephrologist for increasing lethargy and extremely puffy eyelids for a week. Urinalysis showed 4+ proteins but glucose, red blood cells and ketones were absent. Which of the following is the most likely diagnosis? A. Membrano-proliferative glomerulonephritis B. Focal segmental glomerulosclerosis C. Minimal change disease D. Berger's disease Answer: C 2- A 5-year-old child has a 1-day history of cola-coloured urine with red blood cell casts. 2 weeks ago, the child had culture-positive streptococcal tonsillitis. A diagnosis of acute post- streptococcal glomerulonephritis is suspected. Which of the following is the best clinical evidence to support the diagnosis? A. Mildly elevated blood creatinine B. Negative antinuclear antibody C. Positive streptozyme test D. Low C3 Answer: D 3- A 9-year-old girl is brought to the Emergency Department with abnormal movements and a recent history of tea coloured urine. Her parents described a preceding skin eruption. On examination, the child looks unwell, unresponsive and lower limb swelling is noted (see lab results). Blood pressure 155/105 mmHg Heart rate 110/min Respiratory rate 25 /min Temperature 37.4° C Test Result (Normal Values): Hb 78 (112-165 g/L) Platelets count 165 (150-400 x 109/L) Blood urea nitrogen 13.1 (1.8 to 6.4 mol/L) Creatinine 101 (27-88 mol/L) Complement C3 0.5 0.7-1.5 g/L Which of the following is the most likely diagnosis? A. Post streptococcal glomerulonephritis B. Hemolyticureamic syndrome C. Henoch-schönleinpurpura D. Acute renal failure Answer: A 4- A 6-year-old girl developed reddish urine. Her parents stated that she had been constipated for the last 2 weeks and recently became incontinent. On examination, there is abdominal tenderness, and no organomegaly (see lab results). Blood pressure 115/76 mmg Heart rate 76/min Respiratory rate 27 /min Temperature 38.9° C Test Result (Normal Values): WBC 9.5 (4.5-10.5 x 109/L) Hb 79 (112-165 g/L) Platelets count 325 (150-400 × 109/L) Urine Analysis Result (Normal Values): Leukocytes 25-30 (0-3 per high power field) Erythrocytes 30-35 (0-2 per high power field) Protein + (Absent) Blood +++ (Absent) Which of the following is the most likely diagnosis? A. Urinary tract infection B. Henoch-schönleinpurpura C. Autoimmune haemolytic anaemia D. Post streptococcal glomerulonephritis Answer: A 5- A 3-year-ald boy presents with painless abdominal distension, he has had occasional attacks of abdominal pain, vomiting, and bloody urine. On examination, there is a smooth firm mass in the right loin, an absent iris and undescended testes (see lab results). Urinalysis Result (Normal Values): Color: Clear (Clear or light yellow) Appearance: Turbid Clear Specific gravity: 1.025 (1.001-1.030) pH: 7.5 (4.3-8) Leukocytes: 5 (0-3 per high power field) Erythrocytes: 15 (0-2 per high power field) Color: Clear (Clear or light yellow) Which of the following is the most likely diagnosis? A. Hydronephrosis B. Nephroblastoma C. Urinary tract infection D. Polycystic kidney disease Answer: B 6- A 14-month-old girl is brought to the clinic with vomiting and diarrhoea. The mother reports her child is less active. On examination, she has mild dehydration with an estimated fluid deficit of 5% (see lab results). Weight: 10 Kg Test Result Normal Values Sodium: 128 (134-146 mmol/L) Potassium: 3.3 (3.5-5.1 mmol/L) Chloride: 94 (97-108 mmol/L) Bicarbonate: 12 (21-28 mmol/L) How much intravenous fluid (ml/day) should be given? A. 1000 B. 1250 C. 1500 D. 1750 Answer: C 11- A 9-year-old boy presents with abdominal pain and swelling of his right ankle. He had had an upper respiratory tract infection 3 weeks earlier. On examination, he had multiple maculopapular lesions (see image and lab result). Test Result (Normal Value) Erythrocytes 15 (0-2 per high power field) Which of the following is the most appropriate management? A. Antibiotics B. Platelet transfusion C. Supportive treatment D. Factor VIll transfusion Answer: C 12- in which conditions circumcision should be avoided? A. Phimosis B. Hypospadias C. Unilateral Cryptorchidism D. Posterior urethral valve Answer: B 13- A child is brought to the clinic with chronic proteinuria renal disease and hypertension. The parents are concerned about progression to end-stage renal disease. Which of the following drugs would be most useful in preventing this progression? A. Enalapril B. Clonidine C. Propranolol D. Amlodipine Answer: A 14- A 14-year-old boy presents to the clinic complaining of "brown urine" for the past 3 days. 2 weeks ago, he had 2 days of fever and a sore throat, but he improved spontaneously and has been well ever since. On physical examination, only periorbital edema is noted (see lab results). Blood pressure 136/92 mmHg Heart rate 98 /min Respiratory rate 28 /min Temperature 37 ° C Urinalysis Result Normal Values Specific gravity 1.035 1001-1030 Proteins ++ Absent Blood ++ Absent Which of the following is the most likely diagnosis? A. IgA nephropathy B. Acute pyelonephritis C. Hemolytic-uremic syndrome D. Post-streptococcal glomerulonephritis abdomen and extremities Answer: D  Endocrinology 1- An 18-month-old infant presents to the Pediatric Outpatient Clinic for evaluation of delay in walking. It was observed that there is widening of the lower ends of long bones (see lab results). Height 78 cm Weight 10 Kg Test Result Normal Values Calcium total 8.1 2.2-2.7 mmol/L Phosphate 2.1 1.3-2.3 mmol/L Alkaline phosphatase 1020 100-320 U/L Which of the following is the most likely cause? A. Hypophosphatasia B. Renal osteodystrophy C. Vitamin D deficient rickets D. Familial hypophosphatemic rickets Answer: C 2- An 11-month-old child presents with failure to thrive, frequent large volumes of urine, excessive thirst, and 3 episodes of dehydration not associated with vomiting or diarrhoea. Several boys in his family showed similar symptoms. Which of the following is the most likely diagnosis? A. Diabetes mellitus B. Diabetes insipidus C. Water intoxication D. Nephrotic syndrome Answer: B Haematology 1- A 2-year-old girl presents with low energy and failure to thrive. The child was born at 38 weeks gestation with a birth weight of 3.3 kg. The actual body weight was 10 kg (3rd percentile). The mother reports poor appetite and little interest in food. The family follows a strict vegetarian diet. A physical examination confirms pallor of the skin and the mucous membranes. There are cracks in the skin at the corner of the mouth and a peculiar appearance of the nails on the finger and toes (see image and lab results). Heart rate 110/min Respiratory rate 36 /min Temperature 36.8° C Oxygen saturation 95% on room air Test Result Normal Values Hb 90 (112-165 g/L) НСТ 0.29 0.32-0.42 Platelets count 470 150-400 x 109/L MCV 78 80-95 f MCH 25 28-33 pg/cell Which of the following is the most appropriate treatment? A. Transfusion of packed red blood cells B. Erythropoiesis-stimulating agents C. Oral ferrous sulfate D. Parenteral iron Answer: C 2- A newborn presents with jaundice 12 hours after birth. At 36 hours after birth, the jaundice became worse and blood smear was performed (see image and lab results). Test Results Normal Values: Hb 91 (112-165 g/L) Reticulocyte 7 (0.2-1.2 %) Total bilirubin 2800( 97th percentile) and the length is 75 cm (50th percentile). Physical examination confirms pallor of the skin and buccal mucous membranes. There is also a systolic heart murmur and a palpable spleen (see image and lab results). Test Result Normal Values Нb 90 (112-165 g/L) WBC 10 (4.5-10.5 x 109/L) Platelets count 500( 150-400 x 109/L) MCV 70 (80-95 f) Reticulocyte 1.2 (0.2%-1.2%) RBC 3.0 (4.6-4.8 x 1012/L) Which of the following components need to be replaced? A. Iron B. Folic Acid C. Vitamin B12 D. Erythrocytes Answer: A 7- A 16-year-old boy presents with a 6-day fever and abdominal pain. He looks pale and toxic and had a tender and mildly enlarged spleen. What is the most sensitive culture to be recommended? A. Stool or urine culture B. A single blood culture C. Multiple blood cultures D. Bone marrow aspirate culture Answer: D 8- A 5-year-old boy presents with sudden and severe bone pain in his hands and feet, and on examination he appears dehydrated. Blood pressure 105/60 mmHg Heart rate 100 /min Respiratory rate 22 /min Temperature 38.8°C rectal Which of the following is the most likely diagnosis? A. Sickle cell disease B. Alpha thalassemia C.Thalassemia major D. Iron deficiency anaemia Answer: A 9- A 12-year-old girl presents with bleeding gums while brushing her teeth. This had started 1 week ago after a viral upper respiratory tract infection. On physical examination, the only findings are petechiae on her extremities and abdomen. There is no lymphadenopathy, or hepatosplenomegaly (see lab results and report). Test Result Normal Values Hb 130 (112-165 g/L0 НСТ 0.39 (0.32-0.42) MCV 88 (80-95 f1) WBC 8 (4.5-10.5 x 109/L0) Platelets count 20 (150-400 x 109/L) Bone Marrow. Increased megakaryocytes. Which of the following is the most appropriate management? A. Azathioprine B. Prednisolone C. Splenectomy D. Cyclophosphamide Answer: D 10- A 12-year-old girl presents with bleeding gums while brushing her teeth. This had started 1 week ago after a viral upper respiratory tract infection. On physical examination, the only findings are petechiae on her extremities and abdomen. There is no lymphadenopathy, or hepatosplenomegaly (see lab results). Test Result Normal Values Hb 130 (112-165 g/L0 НСТ 0.39 (0.32-0.42) MCV 88 (80-95 f1) WBC 8 (4.5-10.5 x 109/L0) Platelets count 20 (150-400 x 109/L) Which of the following findings is expected in this patient's bone marrow? A. Hypoplasia B. Reduced iron stores C. Megaloblastic changes D. Increased megakaryocytes Answer: D 11- Which of the following conditions can lead to hyposplenism? A. G6PD deficiency B. Sickle cell disease C. Vitamin B12 deficiency D. Hereditary spherocytosis Answer: B 12- A 5-year-old boy presents with sudden and severe bone pain in his hands and feet. On examination, he appears dehydrated (see lab results). Blood pressure 110/60 mmHg Heart rate 125 min Respiratory rate 28 /min Temperature 38.8° C rectal Test Result Normal Values Hb 108 112-165 g/L HCT 0.30 0.32-0.42 MCV 76 80-95 fl Which of the following is responsible for this clinical presentation? A. Aplastic crisis B. Sequestration crisis C. Vaso-occlusive crisis D.Sickle chest syndrome Answer: C 13- A 1-year-old boy is diagnosed with factor VIl deficiency with a level of less than 1%. Which of the following investigations will be affected? A. Bleeding time B. Platelet count C. Prothrombin time D. Activated partial thromboplastin time Answer: C 14- A 1-year-old baby presents with prolonged bleeding after circumcision (see lab results). Test Result Normal Values Bleeding time: 1.6 up to 4 min Prothrombin time: 40 (12-14 sec) APTT 120 (30-40 sec) Platelets count 160 (150-400 x 109/L) Which factor deficiency is the most likely cause? A. VIll B. VII C. IX D. X Answer: D 15- Which of the following signs are more likely to be associated with haemophilia? A. Epistaxis B. Gum bleeding C. Haemarthrosis D. Petechial haemorrhages Answer: C 16- A 15-year-old patient presents for a routine check-up (see lab results). Test Result Normal Values RBC 5.3 4.4-4.8 x 1012/L WBC 68 4.5-10.5 x 109/L Hb 98 112-165 g/L MCV 69 80-95 fl MCHC 261 260-340 g/L Reticulocyte 1.0 0.2-1.2% Which of the following is the most likely diagnosis? A. Sickle cell anaemia B. B-thalassemia trait C. Iron deficiency anaemia disease D. ? Answer: B 17- A 5-day-old infant was delivered normally at home (? “a]ended”) by a midwife. He had never been to a hospital, but now noted to have bleeding from the umbilical cord that seems increasing in severity. He has been breastfed since delivery. The mother had a normal perinatal period, but was diagnosed with epilepsy 10 years ago, and has been taking phenobarbital (see lab results). Test Result Normal Values Bleeding time 3.8 up to 4 min Prothrombin time 21 12-14 sec APTT 46 30-40 sec Which of the following is the most appropriate treatment? A.Corticosteroids B. Platelet transfusion C. Fresh frozen plasma D. Parenteral 1 mg vitamin K1 Answer: D A 15-year-old patient presents for a routine check-up (see lab results). 18- A 1-year-old boy is being investigated for pallor, jaundice, lethargy and delayed growth. On examination, found to be short for his age, with prominent forehead and splenomegaly (see lab results). Test Result Normal Values HB 40 112-165 RDW 14 11.5-14.5% MCV 70 80-95f Reticulocyte 2.4 0.2-1.2% WBC 5.5 4.5-10.5 x 109/L RBC 5.8 4.6-4.8 x 1012/L HB electrophoresis Hb A2 30 2-3% Hb F 50 1-2% Which of the following is the most likely diagnosis? A. Iron deficiency anemia B. B- Thalassemia C. sickle cell disease D. a- Thalassemia Answer: B 19- A preschool child presents for his routine preschool-entry examination (see lab results). Test Result Normal Values: HB 90 112-165 RDW 20 11.5-16% Platelets count 490 150-400 x 109/L MCV 68 80-95 fl MCH 26 28-33 pg/cell MCHC 241 260-340 g/L Reticulocyte 1.1 0.2-1.2 % WBC 7.5 4.5-10.5 x 109/L RBC 5 4.6-4.8 x 1012/L Which of the following is the most likely diagnosis? A. Aplastic anaemia B.Thalassemia minor C. Iron deficiency anaemia D. Hereditary spherocytosis Answer: C 20- A 2-year-old child with sickle cell disease had an upper respiratory tract infection, which was followed by shortness of breath, and pallor. On examination, looked pale, sick and had a splenomegaly (see lab results). Blood pressure 90/60 mmHg Heart rate 110 /min Respiratory rate 25 min Temperature 38.6° C Test Result Normal Values Hb 34 112-165 g/L WBC 3.1 4.5-10.5 x 109/L Lymphocytes 52 20-40 % Neutrophils 58 40-60% Platelets count 166 150-400 x 109/L Reticulocyte 0.1 0.2-1.2 % ESR 25 2-10 mm/h Which of the following is the best immediate management? A. Splenectomy B. Fluids and analgesia C. Intravenous antibiotics D. Packed red cell transfusion Answer: D 21- A 53-day-old boy is referred to the Paediatric Clinic for investigation of anaemia. He was born full term and he is a known case of G6PD deficiency. On examination, both height and weight are in the 10th percentile, the rest of the examination is normal (see lab results). Test Result Normal Values Hb 70 112-165 g/L Platelet count 350 150-400 x 109/L Total bilirubin 25.1